IVF without HSG or Hycosy?

[Sultanafan]

Hi all,
Shortly planning to start private IVF in London (age 39, all tests fine, unexplained infertility after 15 months TTC so clinic advice is to get on with IVF if we can). Had all the usual tests apart from a Fallopian tube check via HSG or Hycosy but the view of my consultant is that it’s not needed if we’ve decided to go for IVF and the 3D ultrasound and my medical history would not indicate any issues with my tubes. Just wondered if anyone else has had similar advice and gone straight to IVF without a HSG or HyCosy? Can’t get rid of the nagging feeling I should have this check before starting IVF.

Hiya @Sultanafan

Personally, I think it depends on if you’d want to continue trying naturally if your tubes were clear?

If you’d still want to pursue IVF anyway then you’d basically be spending £400+ for no reason. With IVF it doesn’t really matter either way as the process/end result is the same.

Hi @Sultanafan so in the UK the only imaging that tends to be done is an US, this can miss uterine abnormalities. A HSG or saline scan are appropriate ways to visualize the anatomy. These tests are often performed up in the work up for IVF elsewhere. I personally think it's ridiculous not to have this kind of imaging before IVF. If there's a hydrosalpinx releasing fluid then implantation will be very difficult, if there are adhesions in the uterus then there is a high risk of implantation failure and miscarriage. A hysteroscopy is not necessary unless there is a reason to do it though, since there is a risk of perforation that could have dire consequences.

I guess whether you pursue more imaging is up to you. I went through 2 transfers before I had more tests including a HSG, this was completely normal reassuringly, but it ruled out Ashermans syndrome (adhesions and scarring in the uterus) and it was reassuring for me to know the anatomy is fine prior to this recent transfer that I've had. If you can find somewhere with a short waiting list then I think it's worth the £500ish that this kind of scan costs, they normally insist on the HSG within the first 2 weeks of a cycle and with abstinence in the cycle. I had mine in the interventional radiology department of Hammersmith and they do a very good job there.

That’s interesting @Gardenlady543. I thought the only way to diagnose hydrosalpinx was via a laparoscopy (which obviously runs into the thousands privately).

Hello! I would say get the images if you can, just to put your mind at ease. At least that's what I would do.

@RiverRiot it should hopefully show up on a HSG, how good a HSG is, is dependent on the person doing it. Interventional radiologists do an amazing job when it comes to this investigation. I asked during mine if a hydrosalpinx would have shown up and she was certain there wasn't one there.

I think overall a HSG is a really good investigation to do before jumping in to anything more invasive.

I didn't have those tests and went straight to IVF after trying for 2 years. The consultant said if there was a problem with my tubes for example, l would need IVF anyway xxx

@Gardenlady543 Thanks for explaining. Much appreciated.

Thanks for your comments everyone, they’re really much appreciated. I think it seems to be a question of personal choice really on this one i.e have the Fallopian tubes checked for (hopefully) some reassurance if we’re going to try naturally for a bit longer or just get on with IVF in the knowledge that, in any scenario following the Fallopian tube check, we’d prefer to just get on with IVF anyway. I also forgot to mention that my ultrasound scan was a 3D Doppler one with blood flow study which I think shows up more than the standard ultrasound and the medical advice that all is fine internally is based on that.